title: Effect of positive well-being on incidence of symptomatic coronary artery disease.
abstract: Although negative emotions and psychiatric morbidity have often been found to increase incident coronary artery disease (CAD) risk, fewer studies have shown positive emotions to be protective against CAD; none have been performed in high-risk healthy populations, taking risk factors into account. Thus, we examined the effect of positive well-being on incident CAD in both a high-risk initially healthy population and a national probability sample. We screened healthy siblings of probands with documented early-onset CAD from 1985 to 2007 in the GeneSTAR (Genetic Study of Atherosclerosis Risk) population and examined sociodemographic data, risk factors, and positive well-being using the General Well-Being Schedule. We further classified siblings into high-, intermediate-, and low-risk strata according to the Framingham risk score and followed them for 5 to 25 years. Siblings (n = 1,483) with greater baseline General Well-Being Schedule total scores were significantly less likely to develop CAD (hazard ratio 0.67, 95% confidence interval 0.58 to 0.79), independent of age, gender, race, and traditional risk factors. Protection was strongest in the high Framingham risk score stratum (hazard ratio 0.52, 95% confidence interval 0.30 to 0.90). The findings were replicated in the first National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study (n = 5,992; hazard ratio 0.87, 95% confidence interval 0.83 to 0.93). In conclusion, positive well-being was associated with nearly a 1/3 reduction in CAD in a high-risk population with a positive family history, a nearly 50% reduction in incident CAD in the highest risk stratum in those with a positive family history, and a 13% reduction in incident CAD in a national probability sample, independent of the traditional CAD risk factors.
authors.affiliation: GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: lryanek@jhmi.edu.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Yanek
authors.forename: Brian G
authors.initials: BG
authors.lastname: Kral
authors.forename: Taryn F
authors.initials: TF
authors.lastname: Moy
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Vaidya
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.forename: Lewis C
authors.initials: LC
authors.lastname: Becker
authors.forename: Diane M
authors.initials: DM
authors.lastname: Becker
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009749:Nutrition Surveys; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings